Correlation of Hamstring Tendon Size in Pre-Operative MRI Measurement with Intra-Operative Graft Size in Primary Anterior Cruciate Ligament (ACL) Reconstruction

Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.

Letters and Visits System Optimization and Implementation

The letters and visits system plays a vital role in government work, serving as a crucial tool for supervising law enforcement and administrative conduct, ensuring public officials’ integrity, and promoting governance by law. As Chinese citizens’ political awareness grows, the volume of letters and visits has increased steadily. This paper reviews the current state of letters and visits information construction, identifies challenges and problems in system integration, presents integration ideas for existing systems, and proposes an innovative approach to letters and visits system integration. This research aims to provide valuable insights and guidance for other units undertaking similar system integration efforts.

A NEW DAY FOR CHINA-VIETNAM RELATIONS Chinese President Xi Jinping’s fruitful visit to Vietnam

Chinese President Xi Jinping made a state visit to Vietnam from December 12 to 13,2023.During the two-day visit,China and Vietnam issued a joint statement on continuing to deepen and elevate their comprehensive strategic cooperative partnership and building a community with a shared future that carries strategic significance.The two sides also signed more than 30 agreements on bilateral cooperation.These developments injected strong momentum into China-Vietnam relations and elevated bilateral ties to a new height.

Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder

AIM:To investigate the preoperative factors that can predict neoplastic polypoid lesions of the gallbladder(PLGs) as well as malignant PLGs.METHODS:A retrospective analysis was conducted on the 210 consecutively enrolled patients who underwent cholecystectomy due to a PLG larger than 10 mm,as was determined by preoperative trans-abdominal ultrasonography or endoscopic ultrasonography.We ana-lyzed the medical,laboratory,radiologic data and the pathologic results.RESULTS:In 210 cases,146 had non-neoplastic polyps(69.5%) and 64 cases were neoplastic polyps(30.5%).An older age(≥ 65 years),the presence of diabetes mellitus(DM) and the size of polyp(≥ 15 mm) were revealed to be independent predictive variables for neoplastic polyps with odd ratios(OR) of 2.27(P = 0.044),2.64(P = 0.021) and 4.94(P < 0.01),respectively.Among the neoplastic PLGs,an older age(≥ 65 years),the presence of DM and polyp size(≥ 15 mm) were associated with malignancy with ORs of 4.97(P = 0.005),6.13(P = 0.001) and 20.55(P < 0.001),respectively.CONCLUSION:Among patients with PLGs larger than 10 mm in size,higher risk groups such as elderly patients more than 65 years old,those with DM or a large polyp size(≥ 15 mm) should be managed by cholecystectomy.

Hypo-Calories with Micronutrients and Fat Emulsion of Pre-Operative Peripheral Parenteral Nutrition in Malnutrition Risk Rectal Cancer Patients: A Retrospective Cross-Sectional Study

Malnutrition has been recognized as a significant risk factor for the post operated patients, especially for those patients undergoing abdominal operations. This study evaluated the effect of hypo-calories with micronutrients of pre-operative peripheral parenteral nutrition support (PPPN) for rectal cancer patients. Retrospective cross sectional study method was used to investigate. We screened rectal cancer patients past year pre-operative with malnutrition risk from our cancer database and divided into 2 groups, received or not received PPPN and compared the post-operative outcomes. The results showed that the post-operative serum albumin of the 25 patients received PPPN averaged 2.5 ± 0.32 g/dl;significantly better than those of the 15 patients not received PPPN (non-PPPN), which averaged 1.92 ± 0.42 g/dl. The first ambulatory time required 3.0 ± 0.8 days for the PPPN, significantly shorter than those for the non-PPPN, which averaged 4.9 ± 2.4 days. Post-operative hospital days for the patients received PPPN were 18.2 ± 10.5 day, also significantly fewer than the non-PPPN, which averaged 33.7 ± 20.0 day. More than 25% of the non-PPPN was infected with sepsis, while none was infected in the PPPN patients. In conclusion, this study verified the benefits of micronutrients of pre-operative peripheral parenteral nutrition support for rectal cancer patients.

Possibility of Extension of Pre-operative Patient Preparation by Antiseptic Shower at the University Hospital Brno

Ensuring complex pre-operative patient preparation before planned surgery is an essential preventive measure of SSIs （surgical site infections）. The aim of this study was to evaluate the difference in the effectiveness of the use of common soap and a tested product to reduce the occurrence of bacterial microorganisms on the skin surface in the area of the assumed surgical incision. Two hypotheses have been identified： H0： the tested product can be considered as beneficial for common pre-operative patient preparation in the incision area in order to significantly reduce the microbial load （decrease in CFU on a defined area of the blood agar by half of the original number and less）. H1： the tested product exceeds common soap by at least 20% when reducing the microbial load in the incision area. There were 80 microbiological prints examined on filter paper using the cultivation method on culture medium. The statistical method of the classic hypothesis test on the binomial distribution parameter versus the one-sided alternative has been used to process the results for the occurrence of microorganisms. The statistical processing of the results obtained by microbiological examination of prints allows for the confirmation of H0 and rejection of the H1 hypothesis. The results have shown the importance of proper pre-operative hygiene of the patient’s skin, regardless of the detergent base.

Pre-Operative Hyponatremia in a High Dependency Cardiovascular Surgical Center of a Tertiary Health Facility in Nigeria: Risk Factors, Prevalence, Clinical Correlates and Treatment Outcome. A Retrospective Cohort Study

Introduction: Hyponatremia is the commonest electrolyte derangement seen in medical and surgical wards and in high dependency treatment units. It is associated with prolonged hospital stay, high economic burden and increased morbidity and mortality. Hyponatremia is well reported in medical and surgical conditions but literature is scanty concerning its relationship with treatment outcome in patients managed in high dependency heart and vascular surgical centers. Objectives: To determine the prevalence, determinants, clinical correlates and outcome of pre-operative hyponatremia. Methods: Retrospective study involving patients that had surgery (cardiac and vascular) between January 2015 and December 2019. Data were obtained from patients’ case files, perioperative and intensive unit charts. All participants with preoperative hyponatremia had their serum sodium corrected to ≥135 mmol before surgical incision and those with hypernatremia had their sodium corrected to <145 mmol. The socio-demographic, clinical, laboratory findings were entered. Statistical analysis was done using student’s t-test and Chi square. Results: Of the 305 participants (186 males and 119 females), pre-operative hyponatremia was found in 30.8% and normonatremia in 59.7%. Pre-operative hyponatremia was more common in advance age, overweight, those presenting for open heart and other major surgeries and those with background chronic heart failure and chronic liver disease. Participants with pre-operative hyponatremia had shortened and also prolonged hospital stay and higher risk of death than with normonatremia. Conclusion: Pre-operative hyponatremia is common in high dependency surgical unit particularly in the elderly, those with comorbidities and those presenting for major heart surgeries. It impacts negatively on the morbidity and mortality as it could shorten hospital stay through death, and could prolong hospital stay with increased health burden on patients, their care givers and the general population. The impact of this finding across different races needs further evaluation.

Effective Communication in the Pre-Operative Environment

Introduction: Building a strong patient rapport is a founding principle instilled early on in medical education. For many specialties, this relationship can be developed through repeated encounters. However, anesthesiologists are limited in opportunity for which such rapport can be built. Therefore, it is critical that the pre-operative visit is used effectively to develop a strong patient-physician relationship and help relieve patient anxiety. Methods: The primary objective of this study was to determine what communication aspects are most important to patients in the pre-operative period. Secondary objectives were to evaluate the effectiveness of our current communication practices and their impact on patient’s anxiety. This study was an anonymous and voluntary survey conducted in the pre-operative area prior to elective surgical cases at Mayo Clinic Arizona from Dec. 2018-Jan. 2019. Patients completed a one-page questionnaire ranking the importance of various communication aspects and its subsequent impact on their anxiety level. Results: Of the communication qualities evaluated, patients most valued their physician’s thoroughness and ability to describe their anesthetic plan. Greater than 95% of patients felt “very satisfied” with their anesthesia provider encounter and on a 1 - 5 point scale, with 5 being the highest, there was an average reduction of 0.75 in anxiety level after completion of the anesthesia interview. Conclusion: Incorporation of and improving these communication aspects during your pre-operative evaluation can help improve rapport, reduce patient anxiety, and improve the patient’s overall experience. Implementing a communication-focused curriculum during training may prove beneficial in improving resident’s effectiveness in communicating.

Transcutaneous acupoint electrical stimulation(TAES)for pre-operative anxiety:a prospective observational pilot investigation

Objective:Transcutaneous acupoint electrical stimulation(TAES)treatment is effective for post-operative anxiety.The investigation was designed to study the feasibility and effectiveness of TAES treatment for pre-operative anxiety.Methods:62 volunteered surgical patients were included in the pilot investigation.They all received TAES treatment for 30 minutes in the evening of the day before operation.Hegu(LI4)and Neiguan(PC6)of both sides were selected as the treatment acupoints.The anxiety degrees were measured by State-Trait Anxiety Inventory.Heart rate and blood pressure were also recorded.Results:After TAES,pre-operative anxiety measured by State-Trait Anxiety Inventory dropped by almost 12%,and both heart rate and systolic blood pressure decreased significantly.Conclusion:The pilot investigation of TAES for pre-operative anxiety can successfully test the feasibility of outcome measurements and provide necessary data for calculating the sample size of a subsequent randomized controlled trial.

The Definition of Non-Urgent Visits to the Emergency Department and Validation of Criteria for Referrals

Background: The centers of disease control and prevention define a non-urgent Emergency Department (NU-ED) visit as a medical condition requiring treatment within more than 24 hours. These visits constitute one of the main reasons for emergency department (ED) overcrowding, which greatly affects healthcare workers’ wellbeing, health costs, patients’ satisfaction and treatment outcomes. Currently, there is no solid definition of non-urgent emergency visits, which is the first step towards dealing and potentially solving this issue. Having that, the aim of the current study is to define and validate the criteria for NU-ED visits in Israel. Methods: This qualitative study included twelve senior physicians and nurses working in Emergency Department and/or Health Maintenance Organizations (HMOs) across Israel. The study was performed using in-depth, semi-structured, open-ended interviews. Qualitative data analysis was performed by conventional content analysis. Results: The urgency of medical visits was defined based on these two questions: 1) Does the medical condition require an immediate treatment? 2) Is the emergency department the only place that can provide the required treatment at a certain timepoint? We found that non-urgent visits mostly occur during the nights and weekends, when medical treatments are not available in the HMOs. Visitors for non-urgent cases mostly complained about minor injuries or chronic conditions, fever, abdominal or chest pain. Most visits occurred based on referral from the family physician or the nurse from the call center. Participants reported a lack of awareness and knowledge about the roles of the EDs and the available options in the HMOs, which seem unable to provide patients with appropriate treatments. The usage of triage scales seems to ensure that patients are being treated based on the clinical urgency of their condition. Medical cases that score above 3 can be defined as non-urgent visits. Therefore, implementation of these scales in the community and their use in decision making of referrals to emergency department might greatly reduce non-urgent visits. Conclusions: Participants defined urgent ED visits as medical situations that need to be treated immediately, while there are no available treatment options in the HMOs. Participants identified many reasons behind NU referrals to the ED, mainly, low awareness about the role of ED, low availability of certain tests in the HMOs, and inability to provide adequate treatment in the community.

Open visitation in the NICU:nurses’perspectives on barriers and facilitators

Objective:This study aimed to investigate the nurses’perspectives on open family visitation and its barriers and facilitators in neonatal intensive care units(NICUs).Methods:This is a descriptive,cross-sectional study.A total of 113 nurses employed in 3 main NICUs of Tabriz participated in the study through the census sampling method.Nurses’perspectives on open visitation and its facilitators and barriers were assessed and analyzed using the Beliefs and Attitudes toward Visitation in NICU Questionnaire(BAVNIQ)and descriptive and analytical statistics,respectively.Results:Approximately 74%of the nurses who participating in the study had a moderate perspective on open visitation.From the nurses’viewpoint,“Parents’low awareness of sensitivity and hygienic principles of the NICU”was the first(90.3%)barrier,and the 2 factors,namely,“physical structure of the ward/lack of sufficient space”and“far distance between family’s residence and the hospital/having another child,”were the second(86.8%)barrier with an equal percentage.Among the facilitating factors,“Supporting employed parents during the neonate’s hospitalization”and“providing facilities for family accommodation in the hospital”were the first(82.3%)and the second(79.6%)facilitators,respectively,for open visitation.Conclusions:The majority of NICU nurses had a moderate perspective on the family open visitation.This reluctance seems to be originated mainly from the factors inhibiting open visitation,making its implementation challenging for nurses.The perspective of the frontline staff in caring for vulnerable infants on facilitators and barriers to open visitation may help policymakers,managers,and relevant officials in decision-making and implementing new visiting policies in the NICUs.

CIIS President Talks with Think Tank Experts during Europe Visit

From February 21 to 25,CIIS President Xu Bu visited the United Kingdom,Belgium,and Switzerland and had extensive and in-depth communication with experts and scholars from more than ten think tanks in the three countries.

Revisiting The Maritime Silk Road In Penglai

Penglai,Yantai City,is located at the northern tip of the Shandong Peninsula,330 kilometers north of Langya Port in Qingdao.In 133 BC,Emperor Wudi(156-87 BC)of the Han Dynasty visited the region during an inspection tour of the eastern part of his empire.He gazed out into the sea in the direction of the mythical Mount Penglai,home of immortals.

ANOTHER FRUITFUL VISIT

Cambodian Prime Minister Hun Sen’s visit to China in early February showcased the special“ironclad”friendship between China and Cambodia Cambodian Prime Minister Hun Sen made an official visit to China from February 9 to 11.The visit was significant in that it took place at the beginning of the year marking the 65th anniversary of the establishment of China-Cambodia diplomatic relations and the“Year of China-Cambodia Friendship.”

机构投资者调研与公司审计意见购买行为:刺激效应还是抑制效应?

公司管理层实施审计意见购买行为及其监管治理是审计学界与监管部门长期关注的重要问题。机构投资者调研作为投资者发掘公司内部信息并缓解信息不对称的一种非正式制度安排,会抑制还是刺激公司实施审计意见购买行为?本文基于我国上市公司的机构投资者调研数据,通过实证研究发现:机构投资者调研会刺激公司实施审计意见购买行为,参与调研机构数量越多、调研频数越高,被调研公司的审计意见购买动机越强,审计意见激进度也越高。进一步分析发现,在机构投资者调研的刺激效应下,公司主要通过选聘“中小”事务所实施审计意见购买,其目的是掩盖公司盈余管理及经营风险的“不利信号”。在缓解内生问题、排除替代性解释、考虑审计轮换制度影响等一系列稳健测试之后,上述结论依然成立。因此,建议会计师事务所应重视由机构投资者调研衍生的客户公司审计风险,市场监管部门应加强公司审计师选聘行为监管,提高机构投资者调研的外部治理效应。

北京协和医院麻醉科进修医师科研规范化培训模式探索

目的 评估北京协和医院麻醉科进修医师科研培训效果,探索麻醉科进修医师科研培训模式。方法 选取2019年1月至2022年12月在北京协和医院麻醉科进行规范化培训的151名进修医师为研究对象,首先通过问卷调查了解其科研背景和科研需求,根据问卷调查的结果,制订全面的培训模式,包括科研经验分享、科研课题参与、学习资源共享、科研脱产训练和专人指导等。共培训6个月,进修结束前通过问卷收集进修医师的反馈。结果 共发放151份调查问卷,回收139份有效问卷。临床科研、教学研究和转化医学是进修医师最感兴趣的科研方向。科研基础知识匮乏、缺乏单独的科研时间和缺乏开展科研工作的经验是进修医师在科研工作中遇到的最大困难。而技术支持、专人指导及给予科研时间是进修医生最期待得到的帮助。通过6个月的培训,88.5%的进修医师认为进修课程对其科研水平有提高作用。同时进修医师也希望今后多开展临床科研设计、基础科研和科研论文撰写方面的培训。结论 科研培训已成为麻醉科进修医师培训的一部分。针对每位进修医师的特点,因材施教,从而实现其进修学习需求,提高继续教育的培养质量。

域外罪犯会见的发展趋向及本土化思考

近年来,域外诸多国家和地区以及国际社会充分认识到罪犯会见在罪犯矫正及预防再犯等方面的重要功能,积极开展罪犯会见领域的基础理论和实证研究,实务部门也积极探索开发会见相关项目与实践,立法部门不断健全完善罪犯会见法律体系,取得了显著成效。域外已有的研究、实践探索及立法完善对健全我国本土化会见体系具有重要意义。我国应重视并加强对会见性质厘清、会见功能界定及会见原则诠释等的基础理论研究,在开展重新犯罪调查过程中持续深入开展加强罪犯会见以预防再犯及代际犯罪的实证调查,推动在基层监狱积极开发着力提升罪犯会见效能的会见项目,同时通过修改完善《监狱法》《罪犯会见通信规定》等不断健全罪犯会见的规范性体系。

移动信息化访视平台在乳腺癌改良根治术患者中的应用效果

目的探讨移动信息化访视平台在乳腺癌改良根治术患者中的应用效果。方法选取2023年2月至9月于东南大学附属中大医院手术室初次接受择期乳腺癌改良根治术的180例患者,采用随机数字表法将其分为两组,每组90例,对照组脱落6例,最终纳入对照组84例和观察组90例。对照组采用常规口头宣教和发放宣传册的方式进行访视,观察组采用移动信息化访视平台进行访视。比较两组术前访视时间、患者满意度、术前准备完善情况、访视前及麻醉等待期焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果观察组术前访视时间短于对照组,患者满意度高于对照组,术前准备完善率高于对照组(P<0.05)。访视前,两组SAS和SDS评分比较,差异无统计学意义(P>0.05);麻醉等待期,两组SAS和SDS评分均低于访视前,且观察组低于对照组(P<0.05)。结论移动信息化访视平台可显著缩短乳腺癌改良根治术患者术前访视时间,提高访视效率和术前准备完善率,缓解患者术前抑郁、焦虑程度,提高患者满意度,使围手术期访视工作更规范、便捷和高效,为手术和患者安全提供保障。

分时段预约胸外科门诊迟到患者特征的回顾性分析

目的分析在分时段预约中四川大学华西医院胸外科门诊患者迟到的特征。方法从四川大学华西医院HIS中提取2019年胸外科患者人口信息及预约就诊信息,共获得有效数据9378例。以正常患者为对照组,采用SPSS 24.0软件对迟到患者进行分析。结果年龄、性别、来源地、就诊类型、就诊时间、预约方式、专家级别、就诊时段是患者迟到的影响因素,差异均有统计学意义(P<0.05)。患者在周一迟到率最高,达到34.6%。每天上午时段的>08:30—09:00迟到率最高,达到78.1%;下午时段的>13:00—13:30迟到率最高,达到65.7%。结论在预约就诊时段内迟到的患者具有一定的特征,需根据相关特征提出解决方案,以提高患者在预约时间段内就诊的依从性。

医疗机构伦理委员会实地访查实践与思考

实地访查是伦理委员会对临床研究实施情况的监督检查方式之一。作者从实地访查的具体实施要点和流程、有因访查和无因访查等访查类型、实地访查开展过程中各方人员的具体职责和访查内容、访查发现问题的讨论及反馈等方面,分享了伦理委员会通过实地访查及时发现研究过程中存在的问题,形成切实可行改进措施,达到保护研究参与者的目的。伦理委员会通过开展实地访查,可以协助临床专业科室及研究团队在临床研究项目准备或实施过程中遵守伦理原则,对医疗机构开展的临床研究进行实时质量控制,及时反馈项目存在的问题并落实整改。伦理委员会通过实地访查,了解临床研究开展的真实情况和实施过程中遇到的具体问题,及时解决,切实保护研究参与者的安全和权益。